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Percoelioscopic treatment of appendicular syndrome in young women

, : Percoelioscopic treatment of appendicular syndrome in young women. Acta Endoscopica 22(1): 53-63

For young women, adnex or appendicular origin in Right Iliac Fossa acute pain syndrome is not easy to establish, frequently responsible of needless appendicectomy. For this reason, we propose a coelioscopic treatment allowing, on one hand avoiding diagnosis mistakes, on the other hand realizing each time it is necessary an appendectomy. 45 women mean-age 26 years (15-44) were treated with this method since May 1989. Was inserted in this series the right iliac fossa acute pain syndromes with a normal pelvic ultrasonographic examination, a fever less than C (celsius), leucocyte less than 13,000, and no parietal contracture. After realizing a pneumoperitoneum with CO2, the abdominal cavity is explored by video-coelioscopy. When appendicectomy was realized, it was executed after diathermy of the meso-appendix and the ligature and section of the appendicular base, pulled out near the right sus-pubic region. In 53.3% cases (n = 24), acute appendicitis lesion was present corroborated by histologic results. In 42.2% cases (n = 19) the pain syndrome was reported as acute adnex diseases which were treated per-coelioscopy: ovarian cyst (n = 11), adnexitis (n = 7), pyosalpinx (n = 1). Appendicectomy was carried out easily per-coelioscopy in 43 cases. In one case, was made a Mac Burney's incision, in the view of an abscess around the appendix. In one case, there was no surgery of appendix in consideration of Crohn's disease suspicion. No mortality. Three superficial infections and a contralateral phlebitis was noticed. Mean time of hospitalization was three days (2 - 5 days). The per-coelioscopic treatment of the right iliac fossa pain syndrome, without serious signs, shows us that in half of the cases an adnex-origin of the pain, confirming the diagnosis of laparoscopy already pointed out by other authors. A specific treatment by coelioscopy was carried out in most of the cases. The other advantages of this coelioscopic treatment, at the difference of classic Mac Burney's incision, is an easier localization and an atraumatic investigation of the appendix, and absence of parietal pain or sequella. Systematic practice of endovaginal ultrasonographic examination could be useful in order to decrease the number of appendicectomies.


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